September 30. 2013 5:57PMIs it ideological to question a plan that could cause more than 20,000 New Hampshire residents to lose their doctor, make all of us wait longer to get health care and put New Hampshire closer to having an income tax? If you said no, then you're on your first step to opposing the Medicaid expansion plan under Obamacare that's currently before the Legislature.

Obamacare supporters have said that the reason why many level-headed elected leaders have resisted adding more than 50,000 new people to the government-run health care program called Medicaid is because of a zealous opposition to the President and his policies. They've said that the federal government will always keep its promises, and that every day that passes after the expansion goes into effect nationally, our state will lose out on "free" money from the federal government.

Consider re-reading that last paragraph and ask yourself who has been drinking the ideological Kool-Aid.

Medicaid expansion supporters have been forced to make these bizarre arguments because looking at the facts gives every reason to oppose this plan that would make care worse for many New Hampshire residents.

According to a report commissioned for the state Department of Health and Human Services by the Lewin Group, expansion would result in 20,500 people being dropped from their high-quality private health insurance into a substandard Medicaid program. These individuals will get shifted from their current insurer network, comprised largely of Anthem and Cigna, into the new Medicaid managed care network, with Meridian, Well Sense and Healthy Families as the providers.

As anyone who has changed health care plans knows, when you switch networks, there's a good chance you will have to change your doctor. These 20,500 people, or 38 percent of the expansion population, would have that change forced on them by Medicaid expansion.

Even more disturbing is the impact to the quality of care for these individuals. Study after study demonstrates that the quality of care under Medicaid is dramatically lower than the care covered by private health insurance. Shifting more than 20,000 people to low-quality care from their current private plan is fundamentally poor public policy and undermines the overall health of our state.

With expansion, we will also need to be prepared to wait longer to see our doctors. A study of Oregon's expansion published in May's New England Journal of Medicine showed that under Medicaid, with its lack of deductibles and minimalist co-payments, health care utilization of those covered exploded. With a major new demand in doctors' time and no new supply of doctors, it means that under expansion doctors will be stretched thin and we should all be prepared to wait more to get an appointment or a referral.

Then there's the question of money. Obamacare supporters claim that the federal government will pay for the entirety of expansion for three years and the vast majority as far as the eye can see, and that the federal government will "always" keep its promise.

These folks might want to ask the 10 hospitals that just lost access to Obamacare policies and the many, many people near these facilities who were promised that "if you like your doctor, you can keep you doctor" how they feel about the promises that were made. These supporters could also look to broken promises on long-term care, caps on out-of-pocket expenses and high-risk pools that have all been shattered, then perhaps they will know why many leaders don't trust Obamacare promises.

That's particularly true when it comes to Medicaid expansion funding, as the U.S. House has already eliminated funding for expansion in the current budget, and last year President Obama moved off the high federal reimbursement rates to reduce the federal deficit. With a nation that's $17 trillion in debt, it's just a matter of time until the federal government steps away from the high cost of expansion, which starts at more than $350 million each year in New Hampshire and then grows. If state taxpayers have to pick that up, it's hello to a state income tax.

If New Hampshire doesn't expand Medicaid, that will leave roughly 22,000 able-bodied adults without health coverage. A better strategy would be a simple plan to cover those individuals and not try to force them, and many others, into an already broken Medicaid program. There are better proposals that can solve this problem if expansion supporters can put their ideology aside and put our state's and our citizens' interests first.

Greg Moore of Manchester is the New Hampshire director of Americans for Prosperity. He served from 2003-2007 as a director at the Department of Health and Human Services.